Low frequency nonevolving generalized periodic epileptiform discharges and the borderland of hypoxic nonconvulsive status epilepticus in comatose patients after cardiac arrest.

To explore the EEG boundary of nonconvulsive status epilepticus (NCSE) and the concept of "possible NCSE", we studied 14 consecutive patients with ≤ 2-Hz nonevolving periodic generalized epileptiform discharges (GPDs) in their first EEG after out of hospital cardiac arrest (OHCA). The pattern was associated with myoclonus in 11 patients. EG reactivity to antiseizure drugs (benzodiazepines and propofol), but without clinical improvement, was noted in 8 patients, satisfying the diagnostic criteria of "possible NCSE". Resolution of GPDs and emergence of physiological rhythms in follow-up EEGs and/or subsequent clinical improvement were noted in 6 of them, strongly suggesting that the initial slow nonevolving GPD pattern reflected NCSE significantly contributing to their coma. Background rhythms from 10 to 90% of the periods between GPDs were noted in 9 patients and appeared to correlate with reactivity of the GPD pattern to antiseizure drugs when 20% or more. Ten patients died, and four were discharged to longer care rehabilitation centers. Although based on few observations, preliminary evidence appears to indicate that in this context, nonevolving GPD frequencies as low as 0.8 Hz can reflect clinically significant NCSE and, therefore, warrant appropriate testing for possible reactivity. There is also some preliminary indication that background rhythms may be another important diagnostic and, perhaps, prognostic indicator, but this needs to be tested in large prospective studies. This article is part of a Special Issue entitled "Status Epilepticus".